Development and validation of the CAM Health Belief Questionnaire (CHBQ) and CAM use and attitudes amongst medical students

Background  

The need for Complementary and Alternative Medicine (CAM) and holistic approaches in allopathic medical school curricula has been well articulated. Despite increased CAM instruction, feasible and validated instruments for measuring learner outcomes in this content area do not widely exist. In addition, baseline attitudes or beliefs of medical students towards CAM, and the factors that may have formed them, including use of CAM itself, remain unreported.     

Utilization and Practice of Traditional/Complementary/Alternative Medicine (TM/CAM) in South Africa

The aim of this study was to conduct a systematic review of published and unpublished research investigating the prevalence of traditional, complementary and alternative medicine (TMCAM) use in the general population. Results found that use of a traditional and/or faith healer seemed to have decreased over the past 13 years (from a range of 3.6–12.7% to 0.1%). The prevalence of traditional male circumcision was found to be 24.8% generally and 31.9% among the African Black racial group. The range of use of alternative and complementary medicine was from 0% to 2.2%. Local utilization surveys of TMCAM for the last illness episode or in the past year showed a variation in use of 6.1% to 38.5%. The prevalence of conditions treated at different TMCAM out-patients settings ranged from chronic conditions, complex of supernatural or psychosocial problems, mental illness, chronic conditions, acute conditions, generalized pain, HIV and other sexually transmitted infections. TM and probably CAM is used by substantial proportions of the general population, but differences in study design and methodological limitations make it difficult to compare prevalence estimates.     

Views of managed care--a survey of students, residents, faculty, and deans at medical schools in the United States

BACKGROUND AND METHODS: Views of managed care among academic physicians and medical students in the United States are not well known. In 1997, we conducted a telephone survey of a national sample of medical students (506 respondents), residents (494), faculty members (728), department chairs (186), directors of residency training in internal medicine and pediatrics (143), and deans (105) at U.S. medical schools to determine their experiences in and perspectives on managed care. The overall rate of response was 80.1 percent. RESULTS: Respondents rated their attitudes toward managed care on a 0-to-10 scale, with 0 defined as "as negative as possible" and 10 as "as positive as possible." The expressed attitudes toward managed care were negative, ranging from a low mean (+/-SD) score of 3.9+/-1.7 for residents to a high of 5.0+/-1.3 for deans. When asked about specific aspects of care, fee-for-service medicine was rated better than managed care in terms of access (by 80.2 percent of respondents), minimizing ethical conflicts (74.8 percent), and the quality of the doctor-patient relationship (70.6 percent). With respect to the continuity of care, 52.0 percent of respondents preferred fee-for-service medicine, and 29.3 percent preferred managed care. For care at the end of life, 49.1 percent preferred fee-for-service medicine, and 20.5 percent preferred managed care. With respect to care for patients with chronic illness, 41.8 percent preferred fee-for-service care, and 30.8 percent preferred managed care. Faculty members, residency-training directors, and department chairs responded that managed care had reduced the time they had available for research (63.1 percent agreed) and teaching (58.9 percent) and had reduced their income (55.8 percent). Overall, 46.6 percent of faculty members, 26.7 percent of residency-training directors, and 42.7 percent of department chairs reported that the message they delivered to students about managed care was negative. CONCLUSIONS: Negative views of managed care are widespread among medical students, residents, faculty members, and medical school deans.     

Use of Complementary and Alternative Medicine: A survey in Turkish Gastroenterology Patients

Background  

The study examined complementary and alternative medicine (CAM) usage by patients attending a Turkish gastroenterology outpatient clinic.     

The CAM Education Program of the National Center for Complementary and Alternative Medicine: an overview.

The authors provide a historical context and overview of the experience of education projects at 14 health professions schools in the United States and the American Medical Students Association that were funded by the National Center for Complementary and Alternative Medicine at the National Institutes of Health in cohorts of five per year in 2000, 2001, and 2002-2003. These 15 projects were designed to incorporate CAM information into the curricula of conventional health professions schools. A longer-term goal was to accelerate the integration of CAM and conventional medicine.The overall program started in 2000 at a time when discussions about the definition, goals, and value of integrative medicine were already well underway. The efforts specific to each project, as well as the shared challenges, accomplishments, and collaborative efforts of all 15 projects, can provide guidance for the education of conventional health care providers about CAM in an integrative medicine environment.Challenging issues that must be faced include (1) the need to develop successful strategies to incorporate information about CAM into already dense health professions school curricula, (2) the need for conventional health professionals to have authoritative resources to provide their patients information about risks and benefits of CAM practices, and (3) the need to identify appropriate roles for CAM practitioners in educating conventional health professionals about CAM therapies. The authors discuss these issues and others and present some recommendations.     

A survey of the use of electronic scientific information resources among medical and dental students

Background  

To evaluate medical and dental students' utilization of electronic information resources.     

Understanding, perceptions and self-use of complementary and alternative medicine (CAM) among Malaysian pharmacy students

Background

Complementary and alternative medicines (CAMs) are being used increasingly across the world. In Australia, community pharmacists are a major supplier of these products but knowledge of the products and interactions with other medicines is poor. Information regarding the use of CAMs by metropolitan pharmacists has been documented by the National Prescribing Service (NPS) in Australia but the views of rural/regional community pharmacists have not been explored. The aim of this pilot study was to explore the knowledge, attitudes and information seeking of a cohort of rural community pharmacists towards CAMs and to compare the findings to the larger NPS study.

Methods

A cross sectional self-administered postal questionnaire was mailed to all community pharmacists in one rural/regional area of Australia. Using a range of scales, data was collected regarding attitudes, knowledge, information seeking behaviour and demographics.

Results

Eighty eligible questionnaires were returned. Most pharmacists reported knowing that they should regularly ask consumers if they are using CAMs but many lacked the confidence to do so. Pharmacists surveyed for this study were more knowledgeable in regards to side effects and interactions of CAMs than those in the NPS survey. Over three quarters of pharmacists surveyed reported sourcing CAM information at least several times a month. The most frequently sought information was drug interactions, dose, contraindications and adverse effects. A variety of resources were used to source information, the most popular source was the internet but the most useful resource was CAM text books.

Conclusions

Pharmacists have varied opinions on the use of CAMs and many lack awareness of or access to good quality CAMs information. Therefore, there is a need to provide pharmacists with opportunities for further education. The data is valuable in assisting interested stakeholders with the development of initiatives to address the gaps in attitudes, knowledge and to improve effectiveness of information seeking behaviour.     

The communication competency of medical students, residents and consultants

Objective

The model of expert performance predicts that neither physicians in training nor experienced physicians will reach an expert level in communication. This study tested this hypothesis.

Methods

Seventy-one students, twenty-five residents and fourteen consultants performed a ‘breaking bad news’ exercise with a simulated patient. Their communication competency was assessed with the CELI instrument. Actor assessments were also obtained. The differences in communication competency between students, residents and consultants were established.

Results

The mean performance scores ranged from bad to adequate. An expert level of performance was seldom reached. Novice students scored lower than the other groups in their competency and in the actor assessment. First-year students scored lower than the consultants in their competency and in the actor assessment. No differences in performance were found between third-year students, interns, residents and consultants.

Conclusion

Students acquire a ‘satisfactory’ level of communication competency early in the curriculum. Communication courses in the curriculum do not enhance this level. Clinical experience has also a limited effect.

Practice implications

The learning conditions for deliberate practice must be fulfilled in medical curricula and in postgraduate training in order to provide medical students and physicians the opportunity to attain an expert level in communication.     

Decisions to use complementary and alternative medicine (CAM) by male cancer patients: information-seeking roles and types of evidence used

Background  

Complementary and Alternative Medicine (CAM) is increasingly popular with cancer patients and yet information provision or discussion about CAM by health professionals remains low. Previous research suggests that patients may fear clinicians' 'disapproval' if they raise the subject of CAM, and turn to other sources to acquire information about CAM. However, little empirical research has been conducted into how cancer patients acquire, and, more importantly evaluate CAM information before deciding which CAM therapies to try.     

The use of Spanish by medical students and residents at one university hospital.

PURPOSE: To describe how medical trainees report communication with Spanish-speaking patients, and to assess trainees' desire to improve their language skills and have those skills formally evaluated. METHOD: A questionnaire was mailed to all fourth-year medical students and non-first-year residents in family practice, pediatrics, medicine, medicine-pediatrics, emergency medicine, and obstetrics-gynecology at the University of Rochester School of Medicine and Dentistry in 2004 (N = 263). RESULTS: The response rate was 92% (241/263). Each respondent had at least one year of clinical experience at the hospital. Of the 83% (199/241) who reported less than conversational Spanish language skills, 53% had taken a history and/or provided medical advice directly to Spanish-speaking patients without any form of interpretation. When an interpreter was used, professional interpretation services were used less frequently than other forms of interpretation (42% versus 58%, p < .05). Analyses were performed on the 68% (164/241) who reported having at least rudimentary Spanish skills: 85% reported that they would probably or definitely participate in further individual language training, 70% expressed at least possible willingness to have their Spanish formally evaluated, and 80% predicted that it is at least possible that they will use their Spanish as attending physicians. CONCLUSIONS: At the time of this study, this hospital's medical students and residents from multiple specialties used inadequate Spanish language skills to provide direct medical care despite the availability of professional interpretation services. Most of these trainees were motivated to improve their Spanish and would welcome evaluation of their language skills.     

Attitudes of faculty, housestaff, and medical students toward clinical practice guidelines.

PURPOSE: To examine attitudes of faculty, housestaff, and medical students toward clinical practice guidelines. METHOD: In a 1997 cross-sectional survey, a two-part, 26-item, self-administered questionnaire was mailed to all faculty, housestaff, and medical students in the department of internal medicine at Case Western Reserve University School of Medicine. The questionnaire asked for demographic information and attitudes toward clinical guidelines. RESULTS: Of 379 persons surveyed, 254 (67%) returned usable questionnaires: 56% of the medical students, 70% of the housestaff, and 73% of the full-time faculty. Medical students reported learning about guidelines predominantly during clerkships in internal medicine (71%) and pediatrics (68%). Overall, the respondents agreed most strongly that guidelines are "useful for the care of common problems," and least strongly that guidelines are "difficult to apply to individual patients" and "reduce physician options in patient care." Faculty were more likely to consider guidelines a "good educational tool" and less likely than were medical students and housestaff to agree that they promote "cookbook medicine." Of 11 influences on clinical decision making, the three groups together rated practice guidelines eighth or ninth. The use of guidelines for academic investigations was rated most appropriate, overall. In terms of their appropriateness, faculty consistently rated the use of guidelines more favorably except for use in malpractice suits. CONCLUSION: Faculty, housestaff, and medical students have significantly different perceptions of and attitudes toward clinical practice guidelines. Further studies are needed to explain the reasons for these differences. Considerable education and involvement must occur at all levels for practice guidelines to be successfully implemented and understood.     

Anxiety of first cadaver demonstration in medical, dentistry and pharmacy faculty students

Anatomy is the fundamental of medical and health professional education. Anatomic dissection enables the examination of the organs in the human cadavers systematically and topographically. The aim of this study was to determine the effect of the first cadaver demonstration and the anxiety of medical, dental and pharmacy students. A questionnaire was distributed to 486 students in the same academic year (2009–2010) at Ege University. The review of anxiety reveals the circumstances such as exhaustion, stress, depression, anxiety, destructive life, deterioration of mental or physical quality or asthenia (over-fatigue), professionally having a serious effect on the students. 486 (85.3 %) students in total participated in this research carried out as based on voluntariness as 338 (93.9 %) students from the medical faculty, 78 (70.9 %) students from the faculty of dentistry and 70 (70 %) students from the faculty of pharmacy. A medium level of anxiety was detected in the students in their first encounter with the cadaver. The state anxiety score (SAS) average taken by all the students who took part in the research is 42.6 ± 5.60 and trait anxiety score average is 46.6 ± 5.0. No discrepancy was detected among the faculties with respect to anxiety score. While the SASs of the male students were higher than the girls, the trait anxiety scores of the girl students were detected to be higher than male students. While the characteristics and the cultural life of our society force the male students into stronger behavioral patterns, they may actually increase their anxiety level in distressed conditions. The fact that trait anxiety is high in both sexes, particularly in female students can be explained by the patient responsibility and the work load undertaken in the professions in the medical field as early as the period of education. Before the students’ applied lessons with the cadavers start, a preparatory session must be planned for this education to decrease the anxiety level by sharing their sensations, feelings and perceptions related to the demonstration.